Comparison of the population of Polish patients participating in the TRANSITION study with the international population: a post hoc analysis.

INTRODUCTION: Heart failure (HF) patients discharged from a hospital are at a high risk of death and rehospitalization. Scarce data are available on the use of sacubitril / valsartan in this population in Poland. OBJECTIVE: The aim of this study was to compare the efficacy and tolerability of sacubitril / valsartan in the group of Polish patients who participated in the TRANSITION study with the patients recruited at other sites. PATIENTS AND METHODS: This is a post hoc secondary analysis of the TRANSITION study comparing sacubitril / valsartan initiation pre- vs postdischarge in 991 patients hospitalized for acute decompensated HF with reduced ejection fraction (HFrEF). The Polish subgroup consisted of 104 patients. RESULTS: Significant differences were identified in the characteristics of Polish vs non­Polish populations. At baseline, the Polish population showed higher proportion of men, higher body mass index, lower heart rate, N­terminal pro-B­type natriuretic peptide and high­sensitivity troponin T levels, and significantly lower New York Heart Association class. The Polish patients were better managed in terms of implanted electrotherapy devices, percutaneous coronary interventions, and drug therapy, and were more often hospitalized. The primary end point of achieving the target dose of sacubitril / valsartan at treatment week 10 was met by 45.6% of the Polish patients and 48.4% of the non­Polish population (P = 0.61). Approximately 90% of the Polish patients received and maintained any sacubitril / valsartan dose for 2 weeks over 10­week treatment vs 87.5% of the non­Polish patients (P = 0.36). The rate of permanent sacubitril / valsartan treatment discontinuation was low in both Polish (3.9%) and non­Polish populations (6.4%) (P = 0.33). CONCLUSIONS: Sacubitril / valsartan can be used safely in the early period after an episode of acute HF both in the Polish and non­Polish patients with HFrEF, and the likelihood to achieve the maximum dose is the same despite significant differences between the studied populations.

A quasi-experimental study examining a nurse-led educational program to improve disease knowledge and self-care for patients with acute decompensated heart failure with reduced ejection fraction.

BACKGROUND: Nurse-led education can improve heart failure (HF) knowledge and self-care behaviors, and consequently lead to better patient outcomes. OBJECTIVES: To assess the effectiveness of "The Weak Heart" educational model in enhancing the level of disease knowledge and self-care behaviors among patients hospitalized with acute decompensated heart failure with reduced ejection fraction (HFrEF). MATERIAL AND METHODS: An evidence-based, standardized educational program was implemented for HF patients in Poland. We compared the initial level of HF knowledge - as rated using a self-developed questionnaire and self-care behaviors, evaluated according to the 9-item European Heart Failure Self-care Behavior Scale (9-EHFScBS) - to the results obtained at the 3-month follow-up period with a sample of patients (n = 231) hospitalized with acute decompensated HF (ADHF). RESULTS: The results showed a significant increase in total score of HF knowledge test depending on the time of measurement (χ2 = 356.526, p < 0.001) and in all individual questions on HF. The significant change of the 9-EHFScBS self-care questionnaire was also found in total score (Z = -7.317, p < 0.001), in all domains: autonomous-based adherence (Z = -5.870, p < 0.001); consulting behavior (Z = -7.238, p < 0.001); provider-based adherence (Z = -4.162; p < 0.001) and in relation to all individual statements except statement 7 ("I eat a low salt diet") and statement 9 ("I exercise regularly"). Within 3 months of hospital discharge, 84% (193 out of 231) of participants visited their primary care physician and 79% (183 out of 231) visited a cardiologist in accordance with their individual treatment plan. CONCLUSIONS: "The Weak Heart" educational model is effective in enhancing the level of HF knowledge and self-care behaviors among patients with decompensation of HFrEF.

Factors Associated with Heart Failure Knowledge and Adherence to Self-Care Behaviors in Hospitalized Patients with Acute Decompensated Heart Failure Based on Data from "the Weak Heart" Educational Program.

PURPOSE: As insufficient adherence to recommendations is a major cause of poor health outcomes in patients with heart failure (HF), it is important to identify the factors that improve disease knowledge and self-care behaviors. We aimed to identify factors associated with HF knowledge and self-care behaviors in patients hospitalized due to acute decompensated heart failure (ADHF) in Poland. PATIENTS AND METHODS: This was a secondary analysis of data from a multi-center, prospective, non-randomized educational program named "The Weak Heart", which was conducted in 14 cardiology centers in Poland. The level of HF knowledge was assessed using a questionnaire developed by the research team, and self-care behaviors were evaluated using the European Heart Failure Self-care Behaviour Scale (9-EHFScBS) questionnaire. RESULTS: The study included 259 patients admitted to the hospital with ADHF. The mean HF knowledge and 9-EHFScBS questionnaire scores were 8.25± 4.34 and 25.2±9.5, respectively. The patients' level of education (P = 0.002), number of prior HF hospitalizations (P = 0.008), and previous disease education (P < 0.001) were independently associated with better HF knowledge. Age (P = 0.03) and disease education (P = 0.02) were independently associated with self-care behaviors. CONCLUSION: The adherence to self-care recommendations among patients with ADHF is insufficient. Disease education positively influenced both HF knowledge and self-care abilities. To improve patients' adherence to HF recommendations, well-designed models of education based on HF management guidelines should be implemented.

A curriculum for heart failure nurses: an expert opinion of the Section of Nursing and Medical Technicians and the Heart Failure Working Group of the Polish Cardiac Society.

The rates of mortality and morbidity due to heart failure (HF) are expected to significantly rise over the next 10 years owing to an ageing population and will be the highest of all rates pertaining to cardiovascular diseases. To face this rapidly progressing problem, that is, the increasing prevalence of HF and need for care of patients with this disease, an attempt was made to develop a curriculum targeted at HF nurses. The HF nurse, as a member of the therapeutic team, has to play an active role in monitoring patients' physical and mental condition, coordinating hospital care, planning intervention after discharge from the hospital, and involving the patient and / or his or her family in self­care, effective cooperation, and communication with the therapeutic team. The curriculum was conceived to complement the knowledge of HF and improve HF nurses' educational skills. The proposed model of education, based on the guidelines of the European Society of Cardiology and led by trained educators, will enable clinicians to fully implement the principles of coordinated care and properly assess the effectiveness of educational interventions in patients with HF.

Initial clinical experience with the first drug (sacubitril/valsartan) in a new class - angiotensin receptor neprilysin inhibitors in patients with heart failure with reduced left ventricular ejection fraction in Poland.

BACKGROUND: Sacubitril/valsartan is the first drug from a new class of angiotensin receptor neprilysin inhibitors (ARNIs) recommended in the new European Society of Cardiology guidelines instead of angiotensin converting enzyme inhibitors (ACEI), or angiotensin receptor blockers (ARB) that are used if ACEI are not tolerated. Sacubitril/valsartan is recommended for further reduction in the risk of hospitalisation or death in outpatients with heart failure with reduced ejection fraction (HFrEF) if symptoms continue despite optimal treatment with ACEI/ARB, beta-blockers, and mineralocorticoid antagonists. AIM: The aim of this study is to present the initial experience with regard to the effectiveness, tolerance, and safety of sacubitril/valsartan in the outpatient cardiology practice in Poland. METHODS: The study is a retrospective analysis of data obtained through a questionnaire filled in by the physicians who initiated the sacubitril/valsartan treatment in patients with HFrEF between 1 June 2016 and 30 September 2016. Patients were followed-up for three months. RESULTS: The analysis included data on 28 patients aged 61 ± 16 years, of whom 85.7% were males. The drug was used in patients in New York Heart Association (NYHA) class I-III. In 25 (89.2%) patients sacubitril/valsartan was started at the lowest dose (24/26 mg BID). During follow-up the sacubitril/valsartan-treated patients had a reduction in HF symptoms assessed using the NYHA functional class (p = 0.001), a significant drop in N-terminal-pro B-type natriuretic peptide levels (mean, from 2900 to 2270 pg/mL; p = 0.008), and improved exercise tolerance, which occurred shortly after treatment initiation - after a mean of 28 days. CONCLUSIONS: It was demonstrated that the use of sacubitril/valsartan in outpatients with HFrEF is safe and is associated with a significant clinical improvement.